The Answer Guys

Doc pain

by Margo A. Ragan

The answer guys” is the nickname grateful patients have given to the medical staff at the Pennsylvania Pain and Spine Institute. According to Drs. David Qu and Robert Kelly, co-founders of the Institute, their mission is to diagnose and treat the agonies of pain with non-invasive and rehabilitation medicine therapies. “Chronic pain can run your life,” said Dr. Qu, “and it is no exaggeration that without proper diagnosis and treatment, pain can ruin the quality of how a patient lives his or her life. Our goal is to find the answers to our patient's pain problems, and our efforts are well received.”

Both Drs. Kelly and Qu have been educated in the top medical schools in the country and discovered their mutual interest in the subspecialty of Pain Medicine. They formed a practice with offices in Chalfont and Quakertown, and added Dr. Douglas Gugger to their team after he had completed a stint as Senior Medical Officer for Forward Operating Base Kalagush while deployed in Afghanistan. “My experiences in the military has given me great respect for those who have served our country,” Dr. Gugger said. “I have witnessed the sacrifices our military has made; consequently, it is a pleasure to welcome fellow veterans to our practice.”

Dr. Gugger explained the difference between acute pain and chronic pain. “Acute pain is what you feel when your hands are on fire. You immediately withdraw from the site of pain. Chronic pain persists.” he said. “It may not necessarily be a result of cancer of a cutting surgery. Chronic pain is real, and oftentimes, difficult to diagnose, but fortunately new procedures are being developed for diagnosis and treatment. You don't have to live a miserable life with chronic pain.”

One of Dr. Gugger's patients survived a horrific car accident, and suffered chronic pain that practically immobilized him. Dr. Gugger used state of the art non-invasive techniques to minimize the man's pain, causing the patient to gratefully say that the doctor “cares from his heart.”

Recently another physician, Dr. David Bozak, has joined this elite team. He specializes in Physical Medicine and Rehabilitation. Dr. Bozak seeks to restore function of nerves, muscles and bones without resorting to surgery. Check out his YouTube applications for Ninja Warrior in 2014 and American Gladiator in 2008. Along with these representations of his athleticism, as a member of the US Cycling Federation, Dr. Bozak is extremely familiar with sports injuries and expert in their treatment.

“Our background and training specialties matters greatly in how we approach our patients' well being,” said Dr. Qu. “Unfortunately, far too many of our patients tell us that no one listens to them. Having chronic pain is vastly different than something like a broken leg. Both are painful, but the leg has a cast on it, which signals the depth of pain the patient is experiencing, and is visible. Chronic pain lurks out of sight.”

Compassion and communication are two common themes of the Institute that Dr Qu expressed as he spoke for his medical team. “At our first meeting with a patient, we spend a large portion of the time listening to the patient and their history. Being a good diagnostician means we gather visual clues and imaging results along with an intensive physical examination,” he said.

I wondered what was the usefulness of being asked, rate your pain level from 1 to 10. How does one know if the pain is a 4 or a 5, and what information is that really giving to the physician.Dr. Qu responded, “We don't have a really objective way of measuring pain. We use those numbers as a guide, but what we are formally doing is observing the patient, looking for clues through body movements. The more relaxed a patient is with us, the more we can learn. It is important to remember that many patients have been told to live with the pain, or that the pain is quote in their head unquote. For the vast majority of our patients, that is farthest from the truth.”

Many patients have been told that the only way to relieve their pain is for them is to undergo drastic surgery. Dr. Qu pointed out that surgical fusion of the spine may lead to other problems. “Since fusion makes it difficult for the patient to move, healthy tissues nearby the surgical site are affected and may develop problems of their own. We believe there are other strategies that can be advocated due to advances in technology.”

One strategy that Dr. Qu explained is a non-surgical treatment called neuromodulation. “With this technique electrical stimulation is applied to deep tissues in the back. That stimulation can apply relief from certain types of lower back pain,” he said.

Surgery is always an option, but thanks to the advances of technology and techniques practiced by this medical team, there are other options to consider first.

One of these new options is an intrathecal pump. “Think of this as a pacemaker for pain,” explained Dr. Qu. “It is a targeted drug delivery system that stops pain signals from being perceived by the brain. Medication is transmitted to the patient at a steady rate, preventing pain from escalating.”

He recalled one patient who benefitted from treatment with the pump. “I remember him as a rather large man, who had suffered from chronic pain for years. He was unable to work, or participate in normal family activities, He seemed to be the perfect candidate for the pump, and after we explained how the pump operated, he immediately consented to having the pump implanted,” Dr. Qu said. “The patient's life changed dramatically for the better. His life was no longer dominated by pain, and he became the husband and father he had always wanted to be.”

This patient admitted to having seen 50 physicians without finding the kind of relief he has found with the implantation of the pump.

According to Dr. Qu, another important aspect of these newer techniques is the significant reduction of opioids for treatment of chronic pain. While opioids are useful for the extreme pain caused by cancer or other catastrophic health conditions, the dangers for self-addiction are well recorded. “Once the pain medication wears off, it may leave the patient with another serious problem of addiction coupled with pain. It is a horrific cycle. Eventually patients become frustrated with their lack of long term relief, along with having to cope with the strong possibility of pain addiction.”

The Institute promotes minimally invasive treatments which could include nutrition counseling, Botox injections for headache pain, and trigger point injections, among many other options too numerous to list here. The world of technology, the Institute says, is changing how chronic pain can be treated.

“Regenerative therapy medicine is a step in the right direction,” Dr. Qu said. “The physician removes healthy cells and implants them in a place where pain is originating. The healthy cells can replace, repair, reprogram or renew the cells which have been damaged or diseased. The process is the least disruptive to the patient's tissues.”

Regenerative therapy can be performed in an out-patient basis with no down time, which is a major plus factor.

Patients have responded in many ways to say thanks to the medical team. As an example, Dr. Kelly had been treating a female patient who had suffered with chronic pain for years, crippling her ability to enjoy a normal life. With proper diagnosis and treatment, she was able to accomplish something she had wanted to do for a long time— she wrote a book and dedicated it to him, in appreciation for literally giving her life back.

Most people recognize and appreciate the years of education and medical training that a physician must undergo. Since Pain Management is a relatively new specialty, I thought it worthwhile to note the rigorous training a pain specialist must follow, as explained to me by Dr. Qu. After completing medical school, there is the matter of a residency that needs to be accomplished. A person who is pursuing a pain specialist board certification, must then apply for a fellowship, which consists of one year of training in all aspects of pain management. Only 200 individuals are accepted for these fellowships on an annual basis. With the completion of the fellowship, the physicians are eligible for board certification in their primary specialty, and become eligible for the subspecialty certification, board certification for Pain Management by the American Board of Medical Specialties.

The Pennsylvania Institute of Pain and Spine Injuries leads the way in the practice of this specialty. For information, visit the Pennsylvania Pain and Spine Institute at www.pennpain.com, telephone 215-395-8888, 700 Horizon Circle, Suite 206, Chalfont PA.

Margo Ragan is a freelance writer and lecturer at Holy Family College who lives in New Hope, PA.